Varicose Veins
Varicose Veins is a topic covered in the 5-Minute Clinical Consult.
To view the entire topic, please log in or purchase a subscription.
Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:
-- The first section of this topic is shown below --
Basics
Description
- Superficial venous disease causing a permanent dilatation, elongation, and tortuosity of superficial veins ≥3 mm in diameter usually occurring in the legs and feet; caused by systemic weakness in the vein wall and may result from congenitally incomplete valves or valves that have become incompetent
- Affects legs where reverse flow occurs when dependent
- Truncal varices involve the great and small saphenous veins; branch varicosities involve the saphenous vein tributaries.
- Categorized as the following and using the clinical, etiologic, anatomic, and pathologic (CEAP) classification:
- Uncomplicated (cosmetic): corresponds to CEAP 0,1, and 2
- With local symptoms (pain confined to the varices, not diffuse): corresponds to CEAP 2
- With local complications (superficial thrombophlebitis, may rupture causing bleeding): corresponds to CEAP 2, 3, 4
- Complex varicose disease (diffuse limb pain, swelling, skin changes/ulcer): corresponds to CEAP 4, 5, 6
- System(s) affected: cardiovascular; skin
ALERT
Ulceration of varicose veins has a high rate of infection, which can lead to sepsis.
Geriatric Considerations
- Common; usually valvular degeneration but may be secondary to chronic venous insufficiency
- Elastic support hose and frequent rests with legs elevated rather than ligation and stripping
Pregnancy Considerations
- Frequent problem
- Elastic stockings are recommended for those with a history of varicosities or if prolonged standing is involved.
Epidemiology
Incidence- Predominant age: middle age
- Predominant gender: female > male (2:1)
Prevalence
- Chronic vein abnormalities are present in approximately 50% of people; varicose veins are present in 10–30% of people
- It is estimated that ~6 to 7 million Americans have chronic venous insufficiency
- Prevalence of chronic venous disease varies among different populations (non-Hispanic Caucasians have more venous disease than African Americans, Asians, and Hispanics
Etiology and Pathophysiology
- Varicose veins are caused by venous insufficiency from faulty valves in ≥1 perforator veins in the lower leg, causing secondary incompetence at the saphenofemoral junction (valvular reflux).
- Valvular dysfunction causing venous reflux and subsequently venous hypertension (HTN)
- Failed valves allow blood to flow in the reverse direction (away from the heart), from deep to superficial and from proximal to distal veins.
- Deep thrombophlebitis
- Increased venous pressure from any cause (e.g., pregnancy, obesity)
- Congenital valvular incompetence
- Trauma (consider arteriovenous fistula; listen for bruit)
- Presumed to be due to a loss in vein wall elasticity with failure of the valve leaflets
- An increase in venous filling pressure is sufficient to promote varicose remodeling of veins by augmenting wall stress and activating venous endothelial and smooth muscle cells.
- Calf muscle pump failure
- Obstruction (proximal)
- Deep venous insufficiency can lead to secondary superficial varicosities via enlarging collaterals
Genetics
No gene has been identified; however, there does appear to be some inherited component.
Risk Factors
- Increasing age
- Family history
- Pregnancy, especially multiple pregnancies
- Prolonged standing
- Obesity
- Sedentary lifestyle
- History of phlebitis or prior thrombosis
- Lower extremity trauma
- Ligament laxity
- Female sex
- Smoking
- Congenital valvular dysfunction
General Prevention
- Maintain a healthy body mass index
- Regular exercise
- Avoid sitting or standing for prolonged periods of time
- Avoid smoking
- Wear compression stockings
Commonly Associated Conditions
- Stasis dermatitis
- Lipodermatosclerosis
- Venous ulceration (usually near medial malleolus/gaiter area
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Superficial venous disease causing a permanent dilatation, elongation, and tortuosity of superficial veins ≥3 mm in diameter usually occurring in the legs and feet; caused by systemic weakness in the vein wall and may result from congenitally incomplete valves or valves that have become incompetent
- Affects legs where reverse flow occurs when dependent
- Truncal varices involve the great and small saphenous veins; branch varicosities involve the saphenous vein tributaries.
- Categorized as the following and using the clinical, etiologic, anatomic, and pathologic (CEAP) classification:
- Uncomplicated (cosmetic): corresponds to CEAP 0,1, and 2
- With local symptoms (pain confined to the varices, not diffuse): corresponds to CEAP 2
- With local complications (superficial thrombophlebitis, may rupture causing bleeding): corresponds to CEAP 2, 3, 4
- Complex varicose disease (diffuse limb pain, swelling, skin changes/ulcer): corresponds to CEAP 4, 5, 6
- System(s) affected: cardiovascular; skin
ALERT
Ulceration of varicose veins has a high rate of infection, which can lead to sepsis.
Geriatric Considerations
- Common; usually valvular degeneration but may be secondary to chronic venous insufficiency
- Elastic support hose and frequent rests with legs elevated rather than ligation and stripping
Pregnancy Considerations
- Frequent problem
- Elastic stockings are recommended for those with a history of varicosities or if prolonged standing is involved.
Epidemiology
Incidence- Predominant age: middle age
- Predominant gender: female > male (2:1)
Prevalence
- Chronic vein abnormalities are present in approximately 50% of people; varicose veins are present in 10–30% of people
- It is estimated that ~6 to 7 million Americans have chronic venous insufficiency
- Prevalence of chronic venous disease varies among different populations (non-Hispanic Caucasians have more venous disease than African Americans, Asians, and Hispanics
Etiology and Pathophysiology
- Varicose veins are caused by venous insufficiency from faulty valves in ≥1 perforator veins in the lower leg, causing secondary incompetence at the saphenofemoral junction (valvular reflux).
- Valvular dysfunction causing venous reflux and subsequently venous hypertension (HTN)
- Failed valves allow blood to flow in the reverse direction (away from the heart), from deep to superficial and from proximal to distal veins.
- Deep thrombophlebitis
- Increased venous pressure from any cause (e.g., pregnancy, obesity)
- Congenital valvular incompetence
- Trauma (consider arteriovenous fistula; listen for bruit)
- Presumed to be due to a loss in vein wall elasticity with failure of the valve leaflets
- An increase in venous filling pressure is sufficient to promote varicose remodeling of veins by augmenting wall stress and activating venous endothelial and smooth muscle cells.
- Calf muscle pump failure
- Obstruction (proximal)
- Deep venous insufficiency can lead to secondary superficial varicosities via enlarging collaterals
Genetics
No gene has been identified; however, there does appear to be some inherited component.
Risk Factors
- Increasing age
- Family history
- Pregnancy, especially multiple pregnancies
- Prolonged standing
- Obesity
- Sedentary lifestyle
- History of phlebitis or prior thrombosis
- Lower extremity trauma
- Ligament laxity
- Female sex
- Smoking
- Congenital valvular dysfunction
General Prevention
- Maintain a healthy body mass index
- Regular exercise
- Avoid sitting or standing for prolonged periods of time
- Avoid smoking
- Wear compression stockings
Commonly Associated Conditions
- Stasis dermatitis
- Lipodermatosclerosis
- Venous ulceration (usually near medial malleolus/gaiter area
There's more to see -- the rest of this entry is available only to subscribers.